AB1006 PULMONARY MANIFESTATIONS OF AXIAL SPONDYLOARTHRITIS (AXSPA): A SYSTEMATIC LITERATURE REVIEW
Authors: K. Vakil-Gilani, T. Cordova, D. Saifer, A. Deodhar
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Common extra musculoskeletal manifestations (EMM) of axSpA include uveitis, inflammatory bowel disease, and psoriasis; and some of the uncommon manifestations include aortic incompetence, conduction abnormalities and IgA nephropathy. We felt that an updated and comprehensive review of pulmonary manifestations of axial spondyloarthritis was needed. <h3>Objectives</h3> To conduct a systematic literature review (SLR) using 2020 PRISMA guidelines on the spectrum of pulmonary manifestations in axial spondyloarthritis. <h3>Methods</h3> Using the 2020 PRISMA guidelines, we conducted a systematic literature review in the PubMed data base. The following MeSH combinations were used: (1) Ankylosing Spondylitis (AS) and interstitial lung disease, (2) AS and lung disease, (3) AS and obstructive sleep apnea, (4) non-radiographic axial spondyloarthritis (nr-axSpA)and lung disease (5) nr-axSpA and obstructive sleep apnea (6) nr-axSpA and interstitial lung disease (7) AS and/or axSpA and obstructive sleep apnea and/or thoracic wall disease. Our search timeline was limited to the past 40 years. The same combination terms were also hand searched. Reviewing of articles were divided between two authors. <h3>Results</h3> Our search led to a total of 10,948 articles and 10,919 were excluded based on relevance after title review (n=10,905), case report study design (n=6), and lack of access to the full manuscript (n=2). Additional 6 articles were excluded based on relevance after the entire manuscripts were read. Twenty nine full length manuscript were ultimately included for further study. All studies included patients with a diagnosis of AS rather than axSpA. The majority of studies were cross-sectional (n=12) followed by review articles (n=10 including one systematic review), and finally cohort studies (n=5 prospective and 1 retrospective). Mean disease duration range was 7.0-31 years. Average age of participants was 30.6 to 57.2, and majority were males (57.1-100%). The most common pulmonary manifestation (40-90%) was pleuro-parenchymal abnormalities noted on high resolution CT scan (HRCT) followed by abnormal pulmonary function tests (PFTs) (15-57%), chest wall movement restriction (50% with manubriosternal and sternoclavicular enthesitis and chest wall pain in 30-60%) and obstructive sleep apnea (OSA) (8.8%-47.8% of AS patients which was significantly higher than controls in all studies except one). OSA was associated with long disease duration and low age at onset of disease. HRCT abnormalities described were interstitial lung disease in 13.7-22%, spontaneous pneumothorax (0.29%), apical fibrosis (1.2%-19%), ground glass opacities (3.6-15%), nodules (3.8-40%), pleural thickening (3.8-45%), honey-combing (5.8%), parenchymal bands (5.8-41%), interlobular septal thickening (5.8-45%), bronchial wall thickening (7.1-41%), emphysema 9-45%, bronchiectasis (9.5-33%), subpleural bands (10.9-35%), tracheal dilation (11.1%), linear opacities (11.7%), and lymphadenopathy (16.7-28.6%). Frequency of apical fibrosis and bronchiectasis increased with disease duration. Subpleural nodules and parenchymal bands were found early in the disease course. Among those with abnormal PFTs, majority were restrictive in pattern (20-57%). A link between COPD and AS was found (46% in one cross-sectional study with 1.45 higher incidence compared to controls). <h3>Conclusion</h3> In our SLR, we identified various pulmonary manifestation in AS patient – the commonest being parenchymal lung disease as seen on HRCT – but there is a lack of controlled trials. Furthermore, there are no data in nr-axSpA patients which remains a major unmet need. No data were available on whether current advanced therapies are disease modifying from pulmonary perspective. Prospective studies are required to evaluate efficacy of novel treatments on lung disease. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Kiana Vakil-Gilani: None declared, Tomas Cordova: None declared, Daniel Saifer: None declared, Atul Deodhar Consultant of: Consulting, advisory boards: AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Janssen, MoonLake, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, Celgene, Galvani, Eli Lilly, Janssen, MoonLake, Novartis, UCB.